Objective To investigate the key clinical diagnostic and therapeutic points, challenges and corresponding strategies for duodenal perforation complicated with recurrent gastrointestinal bleeding in children, and to provide a clinical reference for managing this rare pediatric acute critical condition.Methods The clinical data of a 2-year-and-7-month-old female child with duodenal perforation and recurrent gastrointestinal bleeding were retrospectively analyzed. A systematic review and analysis were conducted from the perspectives of etiology, diagnosis, treatment and postoperative management, combined with relevant domestic and foreign literature over the past decade.Results A 2-year-and-7-month-old Chinese female child presented with viral enteritis initially, which progressed to duodenal perforation complicated with recurrent gastrointestinal bleeding. She received sequential interventions including duodenal perforation repair, gastroscopic exploration, gastrointestinal reconstruction, and transcatheter gastroduodenal artery embolization. The cumulative blood loss exceeded 2000 mL, with total transfusion of 800 mL whole blood, 46 units of packed red blood cells, 2870 mL fresh frozen plasma, and 19 units of cryoprecipitate. Through whole-course multidisciplinary team (MDT) collaboration and refined comprehensive supportive therapy, the child achieved complete recovery with no recurrent bleeding.Conclusion The diagnosis and treatment of duodenal perforation complicated with recurrent gastrointestinal bleeding in children should focus on the core features of pediatric physiological particularities, etiological complexity, age-stage specificity and targeted management of clinical challenges. Adopting multimodal localization approaches, rationally selecting therapeutic regimens and relying on whole-course MDT collaboration can effectively reduce the risk of rebleeding and improve the prognosis of affected children.